Bipolar Disorder and Addiction

A mood disorder affecting close to 4 percent of the American adult population at some point in their lives, per the National Institute of Mental Health (NIMH), bipolar disorder is sometimes referred to as manic-depressive illness. Changes in energy, levels of activity, daily functioning abilities, and mood swings from extreme mania to severe depression are hallmarks of bipolar disorder. Mania is a kind of “high” wherein an individual may feel on top of the world and able to accomplish anything, while depression is the opposite, an extreme “low” that leaves a person feeling “down” and even potentially suicidal.

There are many levels of mania and depression, ranging from severe to less so. Less intense mania is called hypomania, for instance, which unlike full-blown mania may not lead to hospitalization or psychotic symptoms. Individuals may also suffer from mixed episodes, which is when both depressive and manic symptoms occur around the same time. Someone may feel full of energy and sad at the same time, for example. To be diagnosed bipolar, these emotional ups and downs are beyond the realm of “normal” and can impede a person’s everyday life tasks.

Individuals who suffer from bipolar disorder abuse drugs and alcohol at high rates. As the journal Current Psychiatry reports, up to 60 percent of these individuals may suffer from a substance use disorder (SUD) at some time in their life. Alcohol use disorders may be particularly common, with nearly half of those battling bipolar disorder also suffering from one in their lifetime. Stimulant use, such as cocaine, may also be relatively typical for someone diagnosed with bipolar disorder, as the journal Primary Psychiatry reports on a study indicating a lifetime prevalence of a concurrent stimulant use disorder to be close to 20 percent. The journal Addiction & Clinical Practice estimates that individuals suffering from bipolar disorder may be up to seven times more likely to also suffer from an SUD than individuals not battling the mood disorder.

Types and Symptoms of Bipolar Disorder

The National Alliance on Mental Illness (NAMI) reports that the average age for bipolar disorder to be recognized is 25, and it is equally diagnosed in both men and women. NIMH publishes that bipolar disorder is considered severe in more than 80 percent of the adults diagnosed with the disorder in the past year.

NAMI states that there are four main types of bipolar disorder, as classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM), which are:

Bipolar I disorder: At least one episode of severe mania lasting at least a week and often requiring hospitalization has occurred, and depression may or may not be present as well.

Bipolar II disorder: Depressive episodes are intermixed with periods of hypomania, although full-blown mania never occurs.

Cyclothymic disorder: Hypomania and mild depression cycle and continue for at least two years, interspersed with periods of normal moods and functioning, although the periods don’t last longer than two months at a time.

Bipolar disorder unspecified and other specified: These categories include any significant mood alterations that do not meet criteria for other types of bipolar disorder.

Examples of manic and depressive symptoms go beyond your run-of-the-mill mood swings and are indicated by extremes in the case of bipolar disorder.

Why These Disorders Co-Occur

When two disorders are present in one person at the same time, they are said to be co-occurring, and a dual diagnosis is often given. The National Survey on Drug Use and Health (NSDUH) reports that close to 40 percent of all individuals battling a past-year substance use disorder in 2014 also suffered from past-year mental illness in some form (any mental illness, or AMI).

Bipolar disorder and substance abuse and addiction may co-occur at high rates for a variety of reasons. Bipolar disorder may be undiagnosed or misdiagnosed, and individuals may use drugs or alcohol as a way to self-medicate symptoms. Stimulant drugs may temporarily alleviate symptoms of depression, for instance, lifting moods artificially. Alcohol may seem to blunt mania as well. Manic episodes also encourage risky behaviors and reduce inhibitions, making people more likely to abuse substances or engage in other potentially self-harming behaviors. High levels of stress or experiencing a trauma can also encourage a person to try drugs or alcohol as an escape and may also serve to trigger a bipolar episode.

Biology and genetics may be involved in both the onset of addiction and mental illness. Overlapping regions in the brain that may make a person predisposed to developing a mental illness may also be related to a predilection for addiction as well. The National Institute on Drug Abuse (NIDA) publishes that genetics may account for 40-60 percent of a person’s risk for becoming addicted to drugs or alcohol. Bipolar disorder is considered to be one of the most heritable mental health disorders, as the journal Neuroscience reports that genetics may contribute to 60-85 percent of a person’s vulnerability to developing the disorder. Regions of the brain involved in impulse control, emotional regulation, and reward processing are disrupted both through substance abuse and bipolar disorder. Brain chemistry is altered with perpetuated substance abuse, which can cause changes to these regions of the brain as well as in the brain circuitry and functioning itself. This may lead to addiction, which is considered to be a brain disease wherein an individual ceases to be able to control their drug or alcohol use. Since bipolar disorder often appears in early adulthood, potentially before the brain is done developing, this too may predispose someone to abuse drugs or alcohol and develop a substance use disorder.

Complications of Substance Abuse with Bipolar Disorder

While drugs or alcohol may seem to reduce symptoms of bipolar disorder in the short-term, these substances only make matters worse on a long-term basis. Stimulant drugs like cocaine, methamphetamine, or prescription ADHD medications, including amphetamines, produce a euphoric “high” when abused that may lift moods and ease depression. Unfortunately, once these drugs wear off, a “crash” ensues that may actually make depression worse and potentially increase suicidal thoughts and ideations. Around half of those suffering from bipolar disorder, according to clinical samples published by the Psychiatric Times, attempt suicide at least once in their lives.

Alcohol and many drugs also lower inhibitions and decrease self-control, both of which may already be reduced due to bipolar disorder. This may increase the possible risks and potentially hazardous behaviors engaged in by someone in a manic state, leading to accidents, injuries, or other negative consequences. Alcohol may turn a hypomanic state into full-blown mania, Psychology Today warns, as individuals further lose their ability to regulate their mood. Drugs and alcohol may only serve to heighten and exacerbate mood swings as well as episodes of violence or self-harm.

Additionally, substance abuse can interfere with treatment methods for bipolar disorder, possibly interacting with medications prescribed to treat the disorder. Mixing drugs, alcohol, and prescription medications can be dangerous and even cause a potentially life-threatening overdose. Drug overdose is one of the number one causes of accidental death in the United States, as the Centers for Disease Control and Prevention (CDC) reports that nearly 50,000 people died from a fatal drug overdose in 2014. Abusing drugs and/or alcohol while suffering from bipolar disorder increases all of the potential side effects of the substance being abused as well as those of the disorder itself. Individuals battling bipolar disorder who abuse substances may more rapidly develop drug dependence, which often leads to addiction and therefore a dual diagnosis. Co-occurring bipolar disorder and addiction require specialized treatment methods provided in a specialized facility designed to manage both disorders.

Getting Help for Co-Occurring Addiction and Bipolar Disorder

Integrated treatment that treats both disorders at the same time, with the help and direction of highly trained medical, mental health, and substance abuse professionals is generally considered the optimal method of managing symptoms of co-occurring disorders. NAMI reports that integrated treatment is the most common care method for co-occurring disorders. When all healthcare providers work together to design and implement a care plan, symptoms from both disorders can be effectively managed.

In the case of addiction, detox is often the first step in order to aid the individual in reaching a safe and stable physical level. When co-occurring bipolar disorder is also present, medical detox provides the safest and smoothest option for processing drugs or alcohol from the body while minimizing potential withdrawal symptoms. Depression, anxiety, drug cravings, mood swings, and sleep difficulties are common during withdrawal, and when a mental illness like bipolar disorder is also present, these side effects may be amplified.

Medications are often helpful during detox in reducing withdrawal symptoms. When all medical and mental health providers are working together, they can ensure that all medications given will not interfere with bipolar disorder medications. Mental health support can help to keep a person safe from self-harm or harming others while the substances are processed from the body during detox. Detox is generally 5-7 days on average; specific duration often depends on the significance of the physical dependence and the severity of the bipolar symptoms, as well as mitigating environmental and biological factors.

After detox, treatment models range from outpatient care to intensive outpatient treatment to residential, or inpatient, care. All of these models likely use both pharmacological and therapeutic methods during treatment. Medications, such as mood stabilizers, antidepressants, and atypical antipsychotics, are helpful when treating bipolar disorder to regulate the emotional instability that comes with the disorder. Depending on the substance abused, medical professionals may modify the prescription medications given to avoid any adverse reactions and ensure the medication remains effective in treating bipolar symptoms. Some medications may be more useful than others for co-occurring disorders. Lithium, for example, helps to reduce substance abuse in youth also suffering from bipolar disorder as much as three-quarters of the time, Psych Central publishes.

Therapeutic methods, including behavioral therapies like Cognitive Behavioral Therapy (CBT), can help individuals battling co-occurring disorders to better understand their thought processes and how they may lead to negative and destructive behaviors. Triggers and potential stressors can be fully explored with CBT, and coping mechanisms and stress reduction techniques are learned. Education programs and both group and individual sessions work to improve impulse control, manage anger and other volatile emotions, and aid in heightening self-esteem. Integrated Group Therapy (IGT) has been shown to reduce both the severity of mood disorder episodes and drug and alcohol abuse, NIDA publishes. Family therapy can improve communication skills and the family unit as a whole.

Long-term support is perpetuated through continuing therapy and counseling as well as support groups and relapse prevention programs. Many people benefit from joining a 12-Step program that can provide a peer support network of others who can empathize and fully understand the specifics of addiction treatment and recovery. With a comprehensive and individual treatment plan that focuses on the specific circumstances of the person, and that grows with the person as needs change, symptoms of both bipolar disorder and addiction can be managed.